The first thing I'd like to address today is the "Dolemite Da Pimp" fake ID card featured next to yesterday's entry. I'd like to address it because DESC's executive director fears that it may offend some readers. He has a point. For those who have not heard of Dolemite, he's a fictional blaxploitation star from the 1970s. The actor who played him, Rudy Ray Moore, is a singer and stand-up comedian whom some credit with inventing rap music.

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Here's the back-story: A co-worker of mine, Chuck, created the card several months ago as a joke. Chuck, who recently took another job, was the Hawkeye Pierce of DESC. For those who don't remember Robert Altman's film M*A*S*H*, Hawkeye is a brilliant front-line Korean War surgeon with a wickedly subversive sense of humor. He does not laugh to cause offense (though he does cause offense); he laughs so that he may not cry. After creating Dolemite's ID card—with some technical assistance from me—Chuck filled out paperwork to bar him from the shelter. Several days later the shelter's administrator, Karyn, unwittingly paged a "Mr. Dolemite" before a weekly meeting of barred clients. (Chuck swears he did not intend for this to happen.)

Suicide ledgeDigital images sponsored by RadioShack)

Yesterday I promised to discuss mental illness. I also want to talk about its murderous relative, suicide. (Remember the theme song to M*A*S*H*?) Several months ago, a relatively new client calmly smoked a butt, walked to a shelter window, opened it, and leaped to the sidewalk some 45 feet below. Day shift had ended, and I had just left. Chuck hadn't and was first on the scene. The scene he described to me—the client was conscious, gurgling blood through smashed teeth, with broken leg bones piercing the skin—is almost too gruesome to imagine. Chuck spent a good 20 minutes helping the medics load him into the ambulance, and he left covered in blood. Luckily for Chuck this client had no blood-borne diseases. (The most common among our clients are HIV and hepatitis. Hep C, which slowly attacks the liver, is incurable and is carried by about 70 percent of IV drug users.) The client is still living and making a recovery.

DESC's no-harm contract

I should hasten to add that I think our staff acted empathetically and professionally toward this client. He had expressed suicidal thoughts to a night-shift counselor several days before. This counselor gave him emotional support and persuaded him to sign a no-harm contract. (A no-harm contract is a promise made by a suicidal person that he will seek help before killing himself. To an outsider it sounds almost hokey—Camus would certainly take issue with its existentialist implications—but to someone who is in extremis, it can serve as a tangible symbol that somebody cares about him. Studies have proven that it saves lives.) Of course, in any given week there are several clients who voice suicidal thoughts, and in any month there are several no-harm contracts signed. We take every threat seriously, but someone who is truly determined to attempt suicide will do it.

Most of the time, disabling mental illness is less melodramatic but no less tragic. For instance, there is a man in his early 20s who paces the shelter every day. He likes to kickbox the air, and when I say hello, he usually ignores me. When he does open up to me, as he did yesterday, he says things like this: "I am Arabian. That's 'cause I'm the sultan of Saudi Arabia. You have to be Arabian to make money in Saudi Arabia. My name is muy bien. That means money in Arabian … All the stars in space. That's the flag I carry around. I put it in the black hole in my neck. I have this metal plate in my head. I was an android working stuff."

In psych textbooks, this is known as grandiose delusion. If you pretend to understand what he's talking about, or pretend to agree with him, he will latch on and not let go. After listening to him for 10 minutes yesterday, I said goodbye and began to walk away. He followed me across the entire shelter, continuing his monologue.

Because this client is young and obviously psychotic, it is relatively easy to sympathize with him. This is less true for other mentally ill people. As I was leaving the shelter for lunch today, I ran into a Native-American client who stops by the shelter several times a month to seek out his case manager. He doesn't make appointments; he just drops in, with a menacing look on his face, and gets mad when his CM happens to be out. As I passed him in the stairwell, I told him that his CM was not in. "I feel like he's ignoring me," he protested. I tried to assure him that this wasn't the case, but before I could say much, he started to call several black clients on the sidewalk "nigger" and get in their faces. I yelled at him to walk away—for his own safety if nothing else—and luckily he did.